Use of Acute Physiology and Chronic Health Evaluation (APACHE)-II and Red Cell Distribution Width (RDW) for Assessment of Mortality of Patients with Sepsis in ICU.

Critically ill patients of Intensive Care Unit (ICU) need highest level of monitoring, intense nursing care and integrated management which are very expensive and consume significant part of hospital resources. Prediction of outcome from disease has become an essential component of health science. So, various scoring systems have been developed to predict outcome of critically ill patients in ICU. There is no perfect model of severity score to predict ICU mortality. Search for new system is still remaining as continuous efforts to find the best model to get accurate information about the prognosis and outcome of critically ill patients. This observational prospective cohort study was carried out in ICU of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2015 to September 2015 to evaluate the ability of mortality prediction of Acute Physiology and Chronic Health Evaluation (APACHE)-II after adding RDW. Total 62 patients, clinically diagnosed as sepsis with positive culture were included in this study after analyzing selection criteria. APACHE II score model was compared with APACHE II plus RDW score model in relation to mortality outcome assessment. Sensitivity, Specificity, Positive predictive value (PPV), Negative predictive value (NPV) and Receiver Operating Characteristic (ROC) curve were used as parameter to compare the predictive ability of the two models. The derived model APACHE II- RDW was found with higher predictive power (Pearson's correlation coefficient - 0.915) than APACHE II (Pearson's correlation coefficient - 0.885) in relation to mortality (p<0.01). Accuracy was compared by using Receiver Operating Characteristic (ROC) curve between the two models and AUROC was found higher (AUC-0.87) in case of new model compared with conventional model (AUC-0.85). So combination of RDW with APACHE-II increases the predictive ability of the scoring model in relation to mortality.

Evaluation of Pelvic Lymphadenectomy during Radical Hysterectomy for Cervical Cancer.

Cervical cancer is the most common cancer in women in developing countries comprising 20-30% of female cancer. More than 70% of cervical cancer patients of Bangladesh attend in hospital in inoperable stages (IIB, III & IV). Only 30% cases can be treated by primary surgery. This prospective cross-sectional study was conducted by Gynaecologic Oncology Division of the Department of Obstetrics & Gynaecology of Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from November 2011 to May 2012. The objectives of this study were to evaluate the number of pelvic lymph nodes removed, to determine the rate of pelvic lymph node involvement & also to evaluate the relationship between parametrial invasion and pelvic lymph node metastasis. During this period 105 cases underwent type III radical hysterectomy with bilateral pelvic lymph nodes dissection. Majority of the patients (60%) were in the age group of 31-50 years. Regarding histological type, most of the cases were invasive squamous cell carcinoma (85%), followed by adenocarcinoma (9%) and adenosquamous type (2%). According to grading of the tumours, grade I, II, III were 45%, 43%, 8% respectively and in 3% cases grading could not be identified.